Respiratory part 2

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Author:
Michealbledsoe
ID:
217951
Filename:
Respiratory part 2
Updated:
2013-05-05 21:24:02
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Bulthuis Resp
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Respirtory
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  1. what can a child do if they're inhaler cant fit in their mouth
    child can use a spacer
  2. what is the bone grinding sound
    Crepitus
  3. 7th to 10th rib fracture causes higher risk for what
    liver or spleen injury more chance for internal bleeding  (spleen on left)
  4. when the 1st or 2nd rib is fractured it can cause
    damage to intrathoracic vessel
  5. when the rib penetrates the pleura it can lead to what
    pnuemothorax or hemothorax
  6. most organ damage is caused by
    acceleration or deceleration (body stops but organs keep going)
  7. what measures are not recommended in rib fracture
    bandaging and binding of area
  8. In rib fracture breath sounds will be diminished where
    base of the lung
  9. manifestations of rib fracture
    • pain on inspiration
    • coughing
    • diminished breath sounds w/rapid and shallow resp
    • bruising over fracture
    • crepitus
  10. what is flail chest
    • 2 or more broken ribs in a row in more than one place
    • marked by paradoxical movement
    • will have dyspnea, pain and contusion
    • leads to resp failure
    • surgery is usually req
  11. what is pulmonary contusion
    • bruising of lungs
    • can cause aveoli rupture, hemorrhage in aveoli, inflammation and edema monitor pt for 12-24 hours  because resp distress/failure can show up in 12-24 hours
  12. why to watch pts for 12-24 hours after any chest injury
    because resp distress/failure can show up in 12-24 hours
  13. manifestations of pulmonary contusion
    • EARLY SIGNS
    • SOB
    • restlessness
    • apprehension
    • chest pain
    • copious sputum
    • late signs
    • Tachycardia
    • tachypenea
    • cyanotic
    • dyspnea
  14. nursing dx pulmonary contusion
    • impaired gas exchange
    • leading to hypercapnea
  15. tx for pulmonary contusion
    • ICU on ventilator
    • epidural for pain
    • no opoid pain meds due to resp distress
  16. when to suspect smoke inhalation
    • pt in fire in small space
    • burns in facial and thoracic area
    • if nose hairs are singed
    • soot or ash in sputum
  17. facts about smoke inhalation injuries
    • thermal damage can cause edema to upper airways
    • smoke inhalation mostly happens in upper airway
    • if its lower then steam
    • CO or cyanide poisoning may occur
    • chemical damage to airways
  18. carboxyhemoglobin saturation norms
    • <5 norm non smoker
    • <10 norm for smoker
    • 10-20 mild
    • 20-40 moderate
    • 40-60 sever and that is usually fatal
  19. symptoms carboxyhemoglobin saturation
    • in mild to moderate levels
    • headache
    • dizziness
    • dyspnea
    • nausea
    • cherry red appearance
    • moderate to severe levels
    • confusion
    • seizures
    • can have perm neuro damage
    • coma
    • death
    • Pneumonia is common side effect
  20. details of divers reflex
    • heart swells
    • blood vessels constrict
    • work on patient longer
  21. what is associated with wet drowning
    aspiration
  22. what is associated with dry drowning
    asphyxiation
  23. dry drowning causes what
    larygospasms and the spasms stop water from entering lungs
  24. pulmonary edema is marked by what
    pink, frothy sputum, pt can be given diuretic to help restore oxygenation
  25. salt water and drowning...
    salt water is hypertonic, and causes fluids to rush into aveoli thus causing hypovolemia and possible shock
  26. fresh water and drowning
    • fresh water is hypotonic causes cells to lyse causing electrolytes to be diluted, causes dysrythmia and death
    • and impairs surfactant production
  27. both fresh water and salt water drowning can lead to
    pulmonary edema
  28. early and late phases of asthma
    • early phase is constriction
    • late phase is inflammation (could happen 4-12 hours later) (basophils are eosinophilis are activated)
  29. exercise induced asthma facts
    • cold dry air causes 40-90% of bronchial asthma
    • use inhaler before exercise
  30. Airway disorder facts
    -the airway narrow in response to a stimulus and cause limited air flow in and out-it increases the work of breathing and traps the residual volume of the lungs distal to then arrowed airway-inspired air mixes with a large amount of residual air (this reduces the amount of O2 avail in aveoli). Air that we breathe in is mixed with air we can’t get rid of (dilutes it)-decreased alveolar ventilation reduces oxygen available for exchange
  31. what controls smooth muscle
    autonomic nervous system
  32. parasympathetic stimulates
    bronchoconstriction
  33. sympathetic stimulates
    bronchodialation
  34. what foods can be trigger
    fresh fruit and salad, and sulfites in wine and beer
  35. what can breath sounds do right before resp failure
    they can improve
  36. common pharmachological triggers
    ASA and other NSAIDs, betablockers
  37. status asthmaticus means
    • pt does not resp to routine treatment (rescue inhaler)
    • and pt has severe asthma with frequent attacks
  38. intercostal retraction
    in severe asthma attacks you will see the skin pulling into the ribs during breathing
  39. what inhalation med causes thrush
    inhaled steroids
  40. order of inhalation med
    brochodialtor first (can give once every 20 mins up to 3 times) then steroidal inhaler
  41. bronchodialtors or beta agonist
    are abluterol inhalers and nebs
  42. what is solumetrol
    a long acting bronchodialtor
  43. what is a xanthine derivative
    • (chemically related to caffine) theophaphyline is a bronchodialtor (the only xanthine used as a bronchodialtor) it is also an adjunct. Always used with another med.  must draw blood levels freq to measure for toxicity.
    • Aminophyline and dyphiline is the IV form (lot of incompatibilities with this med)
  44. anticholinergics are contridicted in what
    pts with glaucoma and renal failure and prosthetic hypertrophy
  45. anticholinergics  facts
    • take up to an hour to works and ....have same precautions as antihistamines they are preventative
    • Ipratropium bromide (atrovent) and tiotropium (spiriva)
    • not used in acute attack
  46. common systemic side effect of corticosteroids is
    hypoglycemia, poor wound healing
  47. when you give corticosteroid with beta agonist you create what type of effect
    synergistic (meaning it increases the effect of the beta agonist)
  48. what are mast cell stabilizers
    • glucocortiroids, chromolyn, and leukotriene
    • they are preventive and inhibit inflammatory response (create unpleasant taste in mouth)
    • Cromolyn sodium
    • nedocromil
    • (take up to two weeks to work)
  49. oral corticosteroids can cause what
    dry mouth
  50. leukotriene receptor antagonst (LRTAs) are
    • oral
    • preventative
    • anti inflammatory
    • children over 12
    • take on empty stomach
    • can damage liver  (jaundice, dark urine, hives, chalky stool)
    • consist of
    • montelukast (singular)
    • zafirlukast (accolate)
    • zileuton (zyflo)
  51. what is special about montelukast
    • can be used in children over 2
    • and for treatment of allergic rhinitis
  52. differences between COPD and asthma
    • in COPD
    • chronic
    • cough lasting longer than 3 months
    • lungs don't return to normal after excubation
    • (Chronic Bronchitis)
    • thick mucous
    • barrel chest
    • can lead to right sided heart failure
    • more likely to have cyanosis with
    • (emphysema)
    • destruction of aveoli walls
    • tri-pod position
    • an enzyme deficiency can cause (serum alpha 1 antitypsin level)
  53. why do you not want to increase O2 in pts with COPD
    because it will cause hypercapnea (elevated co2) pts will intake too much O2 and cant blow it off will become alkalonic
  54. COPD treatment
    • encourage purse lip breathing
    • encourage pneumonia and flu vaccine
    • give solumedrol mixed with iprotropiaum
  55. diet for COPD
    • cut down down on dairy and salt
    • eat high fat, protein and low carb
    • (think bacon, eggs and hold the toast)
    • peppermint/licorice are natural expectorants
  56. clot (PE) facts
    • could be tumor, air, fat, bone marrow, amniotic fluid
    • clots form in deep vein and mostly in thigh or right side of heart
  57. what is IVC filter
    fliter is inserted in inferior vena cava to prevent clots from traveling to heart
  58. what is streptokinase
    clot buster
  59. Dx test for PE
    • pulmonary angiagram
    • CT of chest
    • plasma D dimer
    • (do coag test after D dimer to determine clot type)

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